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Giusti D, Guemari A, Perotin JM, Fontaine JF, Tonye Libyh M, Gatouillat G, Tabary T, Pham BN, Vitte J. Molecular allergology: a clinical laboratory tool for precision diagnosis, stratification and follow-up of allergic patients. Clin Chem Lab Med 2024; 62:2339-2355. [PMID: 38815141 DOI: 10.1515/cclm-2024-0305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/15/2024] [Indexed: 06/01/2024]
Abstract
Identification of the molecular culprits of allergic reactions leveraged molecular allergology applications in clinical laboratory medicine. Molecular allergology shifted the focus from complex, heterogeneous allergenic extracts, e.g. pollen, food, or insect venom, towards genetically and immunologically defined proteins available for in vitro diagnosis. Molecular allergology is a precision medicine approach for the diagnosis, stratification, therapeutic management, follow-up and prognostic evaluation of patients within a large range of allergic diseases. Exclusively available for in vitro diagnosis, molecular allergology is nonredundant with any of the current clinical tools for allergy investigation. As an example of a major application, discrimination of genuine sensitization from allergen cross-reactivity at the molecular level allows the proper targeting of the culprit allergen and thus dramatically improves patient management. This review aims at introducing clinical laboratory specialists to molecular allergology, from the biochemical and genetic bases, through immunological concepts, to daily use in the diagnosis and management of allergic diseases.
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Affiliation(s)
- Delphine Giusti
- Immunology Laboratory, Biology and Pathology Department, University Hospital of Reims, Reims, France
- University of Reims Champagne Ardenne, EA7509 IRMAIC, Reims, France
| | - Amir Guemari
- Univ Montpellier, Desbrest Institute of Epidemiology and Public Health (IDESP), INSERM, Montpellier, France
| | - Jeanne-Marie Perotin
- Department of Respiratory Diseases, University Hospital of Reims, Reims, France
- University of Reims Champagne Ardenne, INSERM UMR 1250, Reims, France
| | | | - Marcelle Tonye Libyh
- Immunology Laboratory, Biology and Pathology Department, University Hospital of Reims, Reims, France
| | - Gregory Gatouillat
- Immunology Laboratory, Biology and Pathology Department, University Hospital of Reims, Reims, France
| | - Thierry Tabary
- Immunology Laboratory, Biology and Pathology Department, University Hospital of Reims, Reims, France
| | - Bach-Nga Pham
- Immunology Laboratory, Biology and Pathology Department, University Hospital of Reims, Reims, France
- University of Reims Champagne Ardenne, EA7509 IRMAIC, Reims, France
| | - Joana Vitte
- Immunology Laboratory, Biology and Pathology Department, University Hospital of Reims, Reims, France
- University of Reims Champagne Ardenne, INSERM UMR 1250, Reims, France
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Horner AA, Land MH, Abolhosn R, Stern J, Pandya S, Lagier R, Goldberg B, Zeiger RS. Blood stored in EDTA tubes provides accurate peanut basophil activation test results for 48 hours. Ann Allergy Asthma Immunol 2024; 133:445-452.e5. [PMID: 38969008 DOI: 10.1016/j.anai.2024.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/07/2024] [Accepted: 06/17/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND The peanut basophil activation test (BAT) has demonstrated excellent diagnostic accuracy with heparinized blood, but its clinical utility is limited by the short stability of samples stored in this anticoagulant. OBJECTIVE Using EDTA anticoagulated blood, these investigations determined if Peanut BAT sample stability can be extended to 2 days, the minimum stability requirement for diagnostic tests currently offered through American reference laboratories. METHODS Peanut non-allergic control (NAC), peanut IgE sensitized (PS), and peanut allergic (PA) children aged 6 months through 17 years were recruited from members of Kaiser Permanente Southern California. EDTA anti-coagulated blood samples were collected from participants, shipped to a centralized laboratory, and stored at 4oC for peanut BAT testing 1 and 2 days later. RESULTS Peanut BAT results for 23 unblinded participants were used to establish sample rejection and interpretation criteria that were subsequently validated in a prospective double-blind study involving 112 additional children (39-NAC, 36-PS, 37-PA). Of 105 blinded blood samples tested on each study day, 88 (84%) day-1 and 90 (86%) day-2 peanut BAT results were considered interpretable, with diagnostic accuracies of 95.5% and 94.4%, respectively. Moreover, all interpretable PA results were considered positive (100% sensitivity). CONCLUSION Using EDTA anti-coagulated blood samples collected remotely, 1 and 2 days before testing, study results highlight the favorable diagnostic performance characteristics of the peanut BAT and provide further evidence that the test could be readily operationalized for clinical use by interested commercial reference laboratories.
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Affiliation(s)
- Anthony A Horner
- Department of Immune Diagnostics, Quest Diagnostics Nichols Institute, San Juan Capistrano, California.
| | - Michael H Land
- Allergy and Immunology Clinics, Kaiser Permanente Southern California, San Diego, Los Angeles, and Pasadena, California
| | - Rania Abolhosn
- Department of Immune Diagnostics, Quest Diagnostics Nichols Institute, San Juan Capistrano, California
| | - Julie Stern
- Department of Research & Evaluation, Kaiser Permanente Southern California, San Diego, Los Angeles, and Pasadena, California
| | - Shalin Pandya
- Allergy and Immunology Clinics, Kaiser Permanente Southern California, San Diego, Los Angeles, and Pasadena, California
| | - Robert Lagier
- Department of Biostatistics, Quest Diagnostics Nichols Institute, San Juan Capistrano, California
| | - Bruce Goldberg
- Allergy and Immunology Clinics, Kaiser Permanente Southern California, San Diego, Los Angeles, and Pasadena, California; Regional Allergy Laboratory, Kaiser Permanente Southern California, San Diego, Los Angeles, and Pasadena, California
| | - Robert S Zeiger
- Allergy and Immunology Clinics, Kaiser Permanente Southern California, San Diego, Los Angeles, and Pasadena, California; Department of Clinical Sciences, Bernard J. Tyson Kaiser Permanente School of Medicine, Pasadena, California
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Abstract
Current food allergy management universally treats all patients with food allergy as being at risk for anaphylaxis (with the exception perhaps of pollen food allergy syndrome). Thus, patients are told to avoid the allergenic food in all potentially allergic forms and amounts. However, research over the past 2 decades has shown that many patients will tolerate small amounts of the allergen without any allergic reaction. Thus, if one were able to identify the threshold of reactivity, this could change management. At the population level, establishing levels at which the vast majority of patients (e.g., 95%) do not react could have public health ramifications, such as altering labeling laws. At the individual patient level, personal threshold levels could determine avoidance strategies, affect quality of life, and alter treatment decisions, e.g., oral immunotherapy starting doses. In this review, threshold data for various allergens and their potential effect on the management of the patient with food allergy are examined.
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Affiliation(s)
- Jay Adam Lieberman
- From the Division of Allergy and Immunology, Departments of Pediatrics, The University of Tennessee Health Science Center, Memphis, Tennessee
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Piletta-Zanin A, Ricci C, Santos AF, Eigenmann PA. BAT and MAT for diagnosis of peanut allergy: A systematic review and meta-analysis. Pediatr Allergy Immunol 2024; 35:e14140. [PMID: 38822743 DOI: 10.1111/pai.14140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 04/23/2024] [Indexed: 06/03/2024]
Abstract
Basophil activation test (BAT) or the mast cell activation test (MAT) are two in vitro tests that are currently being studied in food allergy as diagnostic tools as an alternative to oral food challenges (OFCs). We conducted a meta-analysis on BAT and MAT, assessing their specificity and sensitivity in diagnosing peanut allergy. Six databases were searched for studies on patients suspected of having peanut allergy. Studies using BAT or MAT to peanut extract and/or component as diagnostic tools with results given in percentage of CD63 activation were included in this meta-analysis. Study quality was evaluated with the QUADAS-2 tool. On the 11 studies identified, eight focused exclusively on children, while three included a mixed population of adults and children. Only one study provided data on MAT, precluding us from conducting a statistical analysis. The diagnostic accuracy of BAT was higher when stimulated with peanut extract rather than Ara h 2 with a pooled specificity of 96% (95% CI: 0.89-0.98) and sensitivity of 0.86 (95% CI: 0.74-0.93). The sensitivity and specificity of BATs in discriminating between allergic and sensitized patients were studied as well, with pooled analysis revealing a sensitivity of 0.86 (95% CI: 0.74; 0.93) and a specificity of 0.97 (95% CI: 0.94, 0.98). BATs, when stimulated with peanut extracts, exhibit a satisfactory sensitivity and specificity for the diagnosis of peanut allergy and can help to discriminate between allergic individuals and those only sensitized to peanuts. More investigations on the potential for MATs diagnostic methods are warranted.
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Affiliation(s)
- Alexandre Piletta-Zanin
- Pediatric Allergy Unit, Department of Woman, Child and Adolescent, University Hospitals of Geneva (HUG), Geneva, Switzerland
| | - Christian Ricci
- Africa Unit for Transdisciplinary Health Research (AUTHeR), North-West University, Potchefstroom, South Africa
| | - Alexandra F Santos
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK
- Children's Allergy Service, Evelina London Children's Hospital, Guy's and St Thomas' Hospital, London, UK
| | - Philippe A Eigenmann
- Pediatric Allergy Unit, Department of Woman, Child and Adolescent, University Hospitals of Geneva (HUG), Geneva, Switzerland
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Li JC, Rotter NS, Stieb ES, Stockbridge JL, Theodorakakis MD, Shreffler WG. Utility of food allergy thresholds. Ann Allergy Asthma Immunol 2024; 132:321-327. [PMID: 38114041 DOI: 10.1016/j.anai.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/05/2023] [Accepted: 12/14/2023] [Indexed: 12/21/2023]
Abstract
Food allergy is a prevalent disease worldwide that is a significant quality-of-life burden, and accidental exposures to food allergens may elicit severe, life-threatening reactions such as anaphylaxis. The threshold level, or the dose that triggers an allergic reaction determined by oral food challenges, varies considerably among individuals suffering from food allergies. Moreover, IgE concentration, diversity, or function can only partially explain this variation in threshold; pathogenic effector TH2 cells have also been found to contribute to the eliciting dose. Though very sensitive to cofactors such as physical activity/stress, the threshold is a stable and reproducible feature of an individual's allergy over periods of many months, made clear in the past several years from treatment studies in which repeated threshold determination has been used as a treatment outcome; however, there also seem to be age-related changes at a population level. More routine determination of food allergy thresholds may help patients stratify risk to improve the management of their food allergy. Precautionary allergen labeling, such as "may contain" labels, often causes confusion since they are inconsistent and regularly contain little to trace allergen residues; thus, food products with such labeling may be unnecessarily avoided. Population-based eliciting dose levels have been determined in the literature; patients at lower risk with higher thresholds may be more confident with introducing foods with precautionary allergen labels. Understanding a patient's threshold level could aid in shared decision-making to determine the most suitable treatment options for patients, including the starting dose for oral immunotherapy and/or the use of biologics.
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Affiliation(s)
- Jennifer C Li
- Food Allergy Center, Massachusetts General Hospital, Boston, Massachusetts; Division of Pediatric Allergy and Immunology, Massachusetts General Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts
| | - Nancy S Rotter
- Food Allergy Center, Massachusetts General Hospital, Boston, Massachusetts; Division of Pediatric Allergy and Immunology, Massachusetts General Hospital, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Elisabeth S Stieb
- Food Allergy Center, Massachusetts General Hospital, Boston, Massachusetts; Division of Pediatric Allergy and Immunology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jennifer L Stockbridge
- Food Allergy Center, Massachusetts General Hospital, Boston, Massachusetts; Division of Pediatric Allergy and Immunology, Massachusetts General Hospital, Boston, Massachusetts
| | - Maria D Theodorakakis
- Food Allergy Center, Massachusetts General Hospital, Boston, Massachusetts; Division of Pediatric Allergy and Immunology, Massachusetts General Hospital, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Wayne G Shreffler
- Food Allergy Center, Massachusetts General Hospital, Boston, Massachusetts; Division of Pediatric Allergy and Immunology, Massachusetts General Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts.
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6
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Nachshon L, Westerhout J, Blom WM, Remington B, Levy MB, Goldberg MR, Epstein-Rigbi N, Katz Y, Elizur A. Sesame eliciting and safe doses in a large sesame allergic population. Allergy 2023; 78:3212-3220. [PMID: 37606275 DOI: 10.1111/all.15863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/02/2023] [Accepted: 07/10/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Sesame is a significant food allergen causing severe and even fatal reactions. Given its increasing prevalence in western diet, sesame is listed as an allergenic food requiring labeling in the United States and EU. However, data on the population reaction doses to sesame are limited. METHODS All sesame oral food challenges (OFCs), performed either for diagnosis or for threshold identification before the beginning of sesame oral immunotherapy (OIT) between November 2011 and July 2021 in Shamir medical center were analyzed for reaction threshold distribution. Safe-dose challenges with 90-120 min intervals were also analyzed. RESULTS Two hundred and fifty patients underwent 338 positive OFCs, and additional 158 safe-dose OFCs were performed. The discrete and cumulative protein amounts estimated to elicit an objective reaction in 1% (ED01) of the entire cohort (n = 250) were 0.8 mg (range 0.3-6.3) and 0.7 mg (range 0.1-7.1), respectively, and those for 5% of the population (ED05) were 3.4 mg (range 1.2-20.6) and 4.5 mg (range 1.2-28.8), respectively. Safe-dose OFCs showed similar values of ED01 (0.8, 0.4-7.5 mg) and ED05 (3.4, 1.2-22.9 mg). While doses of ≤1 mg sesame protein elicited oral pruritus in 11.6% of the patients, no objective reaction was documented to this amount in any of the challenges, including safe-dose OFCs. CONCLUSIONS This study provides data on sesame reaction threshold distribution in the largest population of allergic patients studied, with no right or left censored data, and with validation using a safe-dose OFC. It further supports the current methods for ED determination as appropriate for establishing safety precautions for the food industry.
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Affiliation(s)
- Liat Nachshon
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Be'er Ya'akov, Israel
- Department of Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joost Westerhout
- The Netherlands Organization for Applied Scientific Research TNO, Utrecht, The Netherlands
| | - W Marty Blom
- The Netherlands Organization for Applied Scientific Research TNO, Utrecht, The Netherlands
| | - Benjamin Remington
- Food Allergy Research and Resource Program, Department of Food Science and Technology, University of Nebraska, Lincoln, Nebraska, USA
| | - Michael B Levy
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Be'er Ya'akov, Israel
| | - Michael R Goldberg
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Be'er Ya'akov, Israel
- Department of Pediatrics, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Naama Epstein-Rigbi
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Be'er Ya'akov, Israel
- Department of Pediatrics, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yitzhak Katz
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Be'er Ya'akov, Israel
- Department of Pediatrics, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arnon Elizur
- Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Be'er Ya'akov, Israel
- Department of Pediatrics, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Bourgoin P, Busnel JM. Promises and Remaining Challenges for Further Integration of Basophil Activation Test in Allergy-Related Research and Clinical Practice. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3000-3007. [PMID: 37634807 DOI: 10.1016/j.jaip.2023.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 08/29/2023]
Abstract
More than 20 years after having been initially proposed, the relevance and usefulness of basophil activation test (BAT) for the field of allergy research and testing were demonstrated on many occasions. Leveraging the fully open format of a flexible, whole blood-based functional assay, BAT has been shown to be equally important for fundamental research, clinical research, and diagnosis. Regardless of whether the focus of a study is on the characterization of the allergenic moiety, on the patient side, or on the study of the fundamental processes involved in the allergic disease or its treatment, BAT enables the gathering of very important insights. In spite of this, its full capabilities have yet to be leveraged. Various bottlenecks, including but not limited to assay logistics, robustness, flow cytometry access, and/or expertise, have indeed been limiting its development beyond experts and long-term users. Now, various initiatives, aiming at resolving these bottlenecks, have been launched. If successful, a broader use of BAT could then be contemplated. In such a situation, its more thorough integration in clinical practice has the potential to significantly change the allergic patient's journey.
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Affiliation(s)
- Pénélope Bourgoin
- Global Research Organization, Beckman Coulter Life Sciences, Marseille, France
| | - Jean-Marc Busnel
- Global Research Organization, Beckman Coulter Life Sciences, Marseille, France.
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Carrette M, Couderc L, Bubenheim M, Vidal A, Youssouf A, Boyer O, Marguet C, Martinet J. The combination of Ara h 2-sIgE and basophil activation test could be an alternative to oral food challenge in cases of suspected peanut allergy. Pediatr Allergy Immunol 2023; 34:e14007. [PMID: 37622254 DOI: 10.1111/pai.14007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Most children with peanut sensitisation do not have a clinical peanut allergy (PA). Oral food challenge (OFC) is then necessary to diagnose PA and assess the reactive dose of the allergen. However, OFC is laborious to perform, expensive and stressful. We evaluated whether in vitro tests, such as basophil activation test (BAT), allergen-specific IgE (sIgE) and their combination, could be used to replace OFC for the diagnosis of PA in children. METHODS Ninety-one patients aged 6 months to 18 years with suspected PA were prospectively recruited. These patients then underwent an OFC to assess PA. Whole peanut-sIgE, Ara h 2-sIgE, Ara h 8-sIgE and %CD63+ basophils (CCR3+ /SCClow ) to peanut measured by BAT were investigated for PA diagnosis. RESULTS Forty-one patients had a positive peanut OFC, and the remaining 50 were only sensitised. All patients with Ara h 2-sIgE >7 kUA /L were allergic to peanut. A threshold of 6% for activated basophils yielded a sensitivity of 95% and a specificity of 54%. All patients with Ara h 2-sIgE ≤7 kUA /L and BAT ≤6% (n = 22) had a negative OFC except for one who presented an oral syndrome due to PR-10 sensitisation. CONCLUSIONS We have shown that Ara h 2-sIgE >7 kUA/L is a discriminating threshold for the diagnosis of PA. Furthermore, when Ara h 2-sIgE ≤7 kUA/L and BAT ≤6%, patients do not need to adjust their diet and, thus, do not need an OFC.
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Affiliation(s)
- Marion Carrette
- Department of Immunology and Biotherapy, INSERM U1234, CHU Rouen, Université de Rouen Normandie, Rouen, France
| | - Laure Couderc
- Department of Paediatrics and Adolescent Medicine, CIC INSERM 1404, EA 2656, CHU Rouen, Université de Rouen Normandie, Rouen, France
| | - Michael Bubenheim
- Department of Clinical Research and Innovation, CHU Rouen, Rouen, France
| | - Alexandra Vidal
- Department of Paediatrics and Adolescent Medicine, CIC INSERM 1404, EA 2656, CHU Rouen, Université de Rouen Normandie, Rouen, France
| | - Asmynour Youssouf
- École nationale de la statistique et de l'analyse de l'information (ENSAI), Bruz, France
| | - Olivier Boyer
- Department of Immunology and Biotherapy, INSERM U1234, CHU Rouen, Université de Rouen Normandie, Rouen, France
| | - Christophe Marguet
- Department of Paediatrics and Adolescent Medicine, CIC INSERM 1404, EA 2656, CHU Rouen, Université de Rouen Normandie, Rouen, France
| | - Jérémie Martinet
- Department of Immunology and Biotherapy, INSERM U1234, CHU Rouen, Université de Rouen Normandie, Rouen, France
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9
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Yanagida N, Sato S, Ebisawa M. Relationship between eliciting doses and the severity of allergic reactions to food. Curr Opin Allergy Clin Immunol 2023; 23:226-232. [PMID: 37185827 DOI: 10.1097/aci.0000000000000906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
PURPOSE OF REVIEW Food allergies with low thresholds are associated with frequent accidental allergic reactions. Severe reactions attributable to accidental ingestion often result in a poor quality of life. Nevertheless, no evidence of a relationship between a low threshold dose and the severity of symptoms exists. Therefore, we evaluated recent data regarding the threshold of food allergies based on the oral food challenge (OFC). We also proposed a stepwise OFC method to identify threshold and consumable doses. RECENT FINDINGS A higher specific IgE level and a history of food-induced anaphylaxis were related to low threshold doses and severe reactions during the OFC. In addition, a low threshold dose was not directly correlated with severe reactions. Performing a stepwise OFC may help safely clarify consumable doses and prevent the complete avoidance of allergy-causing foods. SUMMARY Severe food allergies with high specific IgE levels are associated with lower thresholds and more severe reactions. However, the threshold is not directly related to the severity of food-induced allergic symptoms. Identifying a well tolerated consumable dose using a stepwise OFC may help manage food allergies.
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Affiliation(s)
- Noriyuki Yanagida
- Department of Allergy, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
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10
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Yanagida N, Sato S, Nagakura KI, Takahashi K, Fusayasu N, Miura Y, Itonaga T, Ogura K, Ebisawa M. Relationship between serum allergen-specific immunoglobulin E and threshold dose in an oral food challenge. Pediatr Allergy Immunol 2023; 34:e13926. [PMID: 36974646 DOI: 10.1111/pai.13926] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Several studies have reported threshold doses for food allergens. However, evidence regarding potential risk factors for low threshold doses is limited. Moreover, the relationship between threshold dose and specific immunoglobulin E (sIgE) levels to causative foods remains unclear. This study examined the relationship and the risk factors for a low threshold dose. METHODS We recruited children with food allergies and examined the risk factors for a positive oral food challenge (OFC) with a low threshold dose and anaphylaxis. RESULTS We evaluated 2501 children with food allergies (1667 [67%] boys; median age, 4.9 years) to eggs (n = 1096), milk (n = 671), wheat (n = 370), peanuts (n = 258), walnuts (n = 65), and cashews (n = 41). Of these patients, 234 (9%) reacted to ≤30 mg protein of causative foods and 620 (25%) reacted to ≤100 mg protein of causative foods. The sIgE level to causative foods was a significant independent factor for positive OFCs with a threshold dose of ≤30 mg for milk, wheat, and peanuts; ≤ 100 mg for eggs, milk, wheat, peanuts, and cashews; and anaphylaxis from eggs, milk, wheat, peanuts, and walnuts. High sIgE levels to causative foods were associated with a lower threshold dose of the OFC and anaphylaxis during the OFC. CONCLUSIONS Approximately 9% of patients reacted to ≤30 mg protein of causative foods. The potential risks of anaphylaxis should be considered during OFCs for patients with elevated sIgE levels.
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Affiliation(s)
- Noriyuki Yanagida
- Department of Allergy, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
- Department of Pediatrics, National Hospital Organization, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | - Sakura Sato
- Department of Allergy, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | - Ken-Ichi Nagakura
- Department of Pediatrics, National Hospital Organization, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | - Kyohei Takahashi
- Department of Pediatrics, National Hospital Organization, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | - Naoko Fusayasu
- Department of Allergy, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | - Yoko Miura
- Department of Pediatrics, National Hospital Organization, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | - Takaaki Itonaga
- Department of Pediatrics, National Hospital Organization, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | - Kiyotake Ogura
- Department of Pediatrics, National Hospital Organization, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | - Motohiro Ebisawa
- Department of Allergy, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
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11
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Haj Yahia S, Machnes-Maayan D, Frizinsky S, Maoz-Segal R, Offenganden I, Kenett RS, Agmon-Levin N, Hovav R, Kidon MI. Oral immunotherapy for children with a high-threshold peanut allergy. Ann Allergy Asthma Immunol 2022; 129:347-353. [PMID: 35552009 DOI: 10.1016/j.anai.2022.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/19/2022] [Accepted: 05/03/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Between 25% and 30% of children with peanut allergy (PA) have a relatively high-threshold peanut allergy (HTPA), with a single maximal tolerated dose (SMTD) higher than 100 mg of peanut protein (PP). However, this threshold may decrease with time, age, exercise, illness, sleep deprivation, and other covariates. OBJECTIVE To explore the feasibility of a simplified oral immunotherapy (OIT) protocol in a group of children with HTPA. METHODS Children with PA with an SMTD higher than 100 mg were placed on a 40-week OIT protocol of either 300 mg/d of PP or 100 mg/d for 20 weeks followed by 300 mg/d for 20 weeks. A repeat open peanut food challenge was performed after 40 weeks of treatment and at a 6-month follow-up visit. After the 40-week challenge, all children received a maintenance dosage of 2 gPP 3 times a week. RESULTS A total of 28 children with HTPA were enrolled, with 56% boys, 89% younger than 6 years old, and a mean SMTD of 304 mg (95% confidence interval 229-378). All were placed on the described OIT protocol. Overall, 2 children were not compliant and 3 had allergic reactions at home on the dose previously tolerated in clinic, 23 completed the 40-week protocol, and all were able to consume 2 g of PP. The mean tolerated dosage at the 6-month follow-up was 8 g. This enabled most children age-appropriate dietary inclusion of peanut-containing products. CONCLUSION In children with HTPA, a simple, fixed-dose OIT can be both safe and efficacious.
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Affiliation(s)
- Soad Haj Yahia
- Clinical Immunology, Angioedema and Allergy Unit, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Diti Machnes-Maayan
- Clinical Immunology, Angioedema and Allergy Unit, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Safra Children's Hospital, Sheba Medical Centre, Tel Hashomer, Israel
| | - Shirly Frizinsky
- Clinical Immunology, Angioedema and Allergy Unit, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Safra Children's Hospital, Sheba Medical Centre, Tel Hashomer, Israel
| | - Ramit Maoz-Segal
- Clinical Immunology, Angioedema and Allergy Unit, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
| | - Irena Offenganden
- Clinical Immunology, Angioedema and Allergy Unit, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
| | - Ron S Kenett
- KPA Group and Samuel Neaman Institute, Technion, Haifa, Israel
| | - Nancy Agmon-Levin
- Clinical Immunology, Angioedema and Allergy Unit, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Safra Children's Hospital, Sheba Medical Centre, Tel Hashomer, Israel
| | - Ran Hovav
- Plant Sciences Institute, Volcani Center, Ministry of Agriculture, Rishon LeTsiyon, Israel
| | - Mona I Kidon
- Clinical Immunology, Angioedema and Allergy Unit, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Safra Children's Hospital, Sheba Medical Centre, Tel Hashomer, Israel
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12
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Datema MR, Lyons SA, Fernández-Rivas M, Ballmer-Weber B, Knulst AC, Asero R, Barreales L, Belohlavkova S, de Blay F, Clausen M, Dubakiene R, Fernández-Perez C, Fritsche P, Gislason D, Hoffmann-Sommergruber K, Jedrzejczak-Czechowicz M, Jongejan L, Kowalski ML, Kralimarkova TZ, Lidholm J, Papadopoulos NG, Popov TA, Del Prado N, Purohit A, Reig I, Seneviratne SL, Sinaniotis A, Vassilopoulou E, Versteeg SA, Vieths S, Welsing PMJ, Mills ENC, Le TM, Zwinderman AH, van Ree R. Estimating the Risk of Severe Peanut Allergy Using Clinical Background and IgE Sensitization Profiles. FRONTIERS IN ALLERGY 2022; 2:670789. [PMID: 35386994 PMCID: PMC8974676 DOI: 10.3389/falgy.2021.670789] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background: It is not well-understood why symptom severity varies between patients with peanut allergy (PA). Objective: To gain insight into the clinical profile of subjects with mild-to-moderate and severe PA, and investigate individual and collective predictive accuracy of clinical background and IgE to peanut extract and components for PA severity. Methods: Data on demographics, patient history and sensitization at extract and component level of 393 patients with probable PA (symptoms ≤ 2 h + IgE sensitization) from 12 EuroPrevall centers were analyzed. Univariable and penalized multivariable regression analyses were used to evaluate risk factors and biomarkers for severity. Results: Female sex, age at onset of PA, symptoms elicited by skin contact with peanut, family atopy, atopic dermatitis, house dust mite and latex allergy were independently associated with severe PA; birch pollen allergy with mild-to-moderate PA. The cross-validated AUC of all clinical background determinants combined (0.74) was significantly larger than the AUC of tests for sensitization to extract (0.63) or peanut components (0.54-0.64). Although larger skin prick test wheal size, and higher IgE to peanut extract, Ara h 1 and Ara h 2/6, were associated with severe PA, and higher IgE to Ara h 8 with mild-to-moderate PA, addition of these measurements of sensitization to the clinical background model did not significantly improve the AUC. Conclusions: Models combining clinical characteristics and IgE sensitization patterns can help establish the risk of severe reactions for peanut allergic patients, but clinical background determinants are most valuable for predicting severity of probable PA in an individual patient.
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Affiliation(s)
- Mareen R Datema
- Department of Experimental Immunology, Amsterdam University Medical Center, Amsterdam, Netherlands.,Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Sarah A Lyons
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Montserrat Fernández-Rivas
- Allergy Department, Hospital Clinico San Carlos, Instituto de Investigacion Sanitario San Carlos, Madrid, Spain
| | - Barbara Ballmer-Weber
- Allergy Unit, Department of Dermatology, University Hospital, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland.,Clinic for Dermatology and Allergology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - André C Knulst
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Riccardo Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Italy
| | - Laura Barreales
- Clinical Epidemiology Unit, Preventive Medicine Department, Hospital Clinico San Carlos, Instituto de Investigacion Sanitario San Carlos, Madrid, Spain
| | - Simona Belohlavkova
- Department of Allergology and Immunology, Faculty of Medicine in Pilsen, Charles University, Prague, Czechia
| | - Frédéric de Blay
- Allergy Division, Chest Disease Department, Strasbourg University Hospital, Strasbourg, France
| | - Michael Clausen
- Faculty of Medicine, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland
| | | | - Cristina Fernández-Perez
- Clinical Epidemiology Unit, Preventive Medicine Department, Hospital Clinico San Carlos, Instituto de Investigacion Sanitario San Carlos, Madrid, Spain
| | - Philipp Fritsche
- Allergy Unit, Department of Dermatology, University Hospital, Zurich, Switzerland
| | - David Gislason
- Faculty of Medicine, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland
| | | | | | - Laurian Jongejan
- Department of Experimental Immunology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Marek L Kowalski
- Department of Immunology, Rheumatology and Allergy, Faculty of Medicine, Medical University of Lodz, Lodz, Poland
| | | | | | - Nikolaos G Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece.,Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, United Kingdom
| | - Todor A Popov
- Clinic of Occupational Diseases, University Hospital Sv. Ivan Rilski, Sofia, Bulgaria
| | - Nayade Del Prado
- Clinical Epidemiology Unit, Preventive Medicine Department, Hospital Clinico San Carlos, Instituto de Investigacion Sanitario San Carlos, Madrid, Spain
| | - Ashok Purohit
- Allergy Division, Chest Disease Department, Strasbourg University Hospital, Strasbourg, France
| | - Isabel Reig
- Allergy Department, Hospital Clinico San Carlos, Instituto de Investigacion Sanitario San Carlos, Madrid, Spain
| | - Suranjith L Seneviratne
- Institute of Immunity and Transplantation, University College London, London, United Kingdom
| | | | - Emilia Vassilopoulou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece
| | - Serge A Versteeg
- Department of Experimental Immunology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Stefan Vieths
- Paul-Ehrlich-Institut, Federal Institute for Vaccines and Biomedicines, Langen, Germany
| | - Paco M J Welsing
- Division of Internal Medicine and Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - E N Clare Mills
- Division of Infection, Immunity and Respiratory Medicine, Manchester Institute of Biotechnology, University of Manchester, Manchester, United Kingdom
| | - Thuy-My Le
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Aeilko H Zwinderman
- Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Ronald van Ree
- Department of Experimental Immunology, Amsterdam University Medical Center, Amsterdam, Netherlands.,Department of Otorhinolaryngology, Amsterdam University Medical Center, Amsterdam, Netherlands
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13
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Briceno Noriega D, Teodorowicz M, Savelkoul H, Ruinemans-Koerts J. The Basophil Activation Test for Clinical Management of Food Allergies: Recent Advances and Future Directions. J Asthma Allergy 2021; 14:1335-1348. [PMID: 34754200 PMCID: PMC8572092 DOI: 10.2147/jaa.s237759] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/06/2021] [Indexed: 12/15/2022] Open
Abstract
The basophil activation test (BAT) is an ex vivo functional assay that measures by flow cytometry the degree of basophil degranulation after stimulation with an allergen. In recent years, there has been an increased interest in the diagnostic value of the BAT as it has the potential to mimic the clinical phenotype of sIgE sensitized patients, in contrast to allergen-specific IgE levels. This diagnostic potential would be of particular interest for food allergies present early in life such as peanut, cow’s milk and eggs, which require an expensive, time-consuming and patient unfriendly oral food challenge (OFC) for diagnosis. However, routine applications of the BAT for clinical use are not yet feasible due to the lack of standardized protocols and large clinical validation studies. This review will summarize the current data regarding the application of the BAT in food allergy (FA) for cow’s milk, egg and peanut, being the most common causes of FA in children. Additionally, it will discuss the hurdles for widespread clinical use of the BAT and possible future directions for this diagnostic procedure.
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Affiliation(s)
- Daniela Briceno Noriega
- Cell Biology and Immunology Group, Wageningen University & Research, Wageningen, the Netherlands
| | - Malgorzata Teodorowicz
- Cell Biology and Immunology Group, Wageningen University & Research, Wageningen, the Netherlands
| | - Huub Savelkoul
- Cell Biology and Immunology Group, Wageningen University & Research, Wageningen, the Netherlands
| | - Janneke Ruinemans-Koerts
- Cell Biology and Immunology Group, Wageningen University & Research, Wageningen, the Netherlands.,Laboratory of Clinical Chemistry and Hematology, Rijnstate Hospital, Arnhem, the Netherlands
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14
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Czolk R, Klueber J, Sørensen M, Wilmes P, Codreanu-Morel F, Skov PS, Hilger C, Bindslev-Jensen C, Ollert M, Kuehn A. IgE-Mediated Peanut Allergy: Current and Novel Predictive Biomarkers for Clinical Phenotypes Using Multi-Omics Approaches. Front Immunol 2021; 11:594350. [PMID: 33584660 PMCID: PMC7876438 DOI: 10.3389/fimmu.2020.594350] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 12/11/2020] [Indexed: 01/22/2023] Open
Abstract
Food allergy is a collective term for several immune-mediated responses to food. IgE-mediated food allergy is the best-known subtype. The patients present with a marked diversity of clinical profiles including symptomatic manifestations, threshold reactivity and reaction kinetics. In-vitro predictors of these clinical phenotypes are evasive and considered as knowledge gaps in food allergy diagnosis and risk management. Peanut allergy is a relevant disease model where pioneer discoveries were made in diagnosis, immunotherapy and prevention. This review provides an overview on the immune basis for phenotype variations in peanut-allergic individuals, in the light of future patient stratification along emerging omic-areas. Beyond specific IgE-signatures and basophil reactivity profiles with established correlation to clinical outcome, allergenomics, mass spectrometric resolution of peripheral allergen tracing, might be a fundamental approach to understand disease pathophysiology underlying biomarker discovery. Deep immune phenotyping is thought to reveal differential cell responses but also, gene expression and gene methylation profiles (eg, peanut severity genes) are promising areas for biomarker research. Finally, the study of microbiome-host interactions with a focus on the immune system modulation might hold the key to understand tissue-specific responses and symptoms. The immune mechanism underlying acute food-allergic events remains elusive until today. Deciphering this immunological response shall enable to identify novel biomarker for stratification of patients into reaction endotypes. The availability of powerful multi-omics technologies, together with integrated data analysis, network-based approaches and unbiased machine learning holds out the prospect of providing clinically useful biomarkers or biomarker signatures being predictive for reaction phenotypes.
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Affiliation(s)
- Rebecca Czolk
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
- Faculty of Science, Technology and Medicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Julia Klueber
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
- Department of Dermatology and Allergy Center, Odense Research Center for Anaphylaxis, University of Southern Denmark, Odense, Denmark
| | - Martin Sørensen
- Department of Pediatric and Adolescent Medicine, University Hospital of North Norway, Tromsø, Norway
- Pediatric Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Paul Wilmes
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Françoise Codreanu-Morel
- Department of Allergology and Immunology, Centre Hospitalier de Luxembourg-Kanner Klinik, Luxembourg, Luxembourg
| | - Per Stahl Skov
- Department of Dermatology and Allergy Center, Odense Research Center for Anaphylaxis, University of Southern Denmark, Odense, Denmark
- RefLab ApS, Copenhagen, Denmark
- Institute of Immunology, National University of Copenhagen, Copenhagen, Denmark
| | - Christiane Hilger
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Carsten Bindslev-Jensen
- Department of Dermatology and Allergy Center, Odense Research Center for Anaphylaxis, University of Southern Denmark, Odense, Denmark
| | - Markus Ollert
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
- Department of Dermatology and Allergy Center, Odense Research Center for Anaphylaxis, University of Southern Denmark, Odense, Denmark
| | - Annette Kuehn
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
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